Provider First Line Business Practice Location Address:
202 E NORTH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CALIFORNIA
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65018
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-796-2222
Provider Business Practice Location Address Fax Number:
573-796-4184
Provider Enumeration Date:
07/08/2010